Severe COPD Emergency Hernia Technique — FRCA Final MCQ

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HardRegional AnaesthesiaSevere COPD Emergency Hernia TechniqueFRCA Final

A 70-year-old man (ASA IV) with severe COPD (FEV1 0.7L, on home oxygen) requires emergency surgery for incarcerated inguinal hernia. He cannot lie flat. ABG on 2L O2: pH 7.34, PaCO2 8.2 kPa, PaO2 7.5 kPa, HCO3 33 mmol/L. Which anaesthetic technique is safest?

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Correct answer: E — Local anaesthesia with ilioinguinal/iliohypogastric nerve block and surgeon infiltration

In a patient with very severe COPD (FEV1 0.7L, type 2 respiratory failure, oxygen-dependent) who cannot lie flat, local anaesthetic techniques avoiding GA and neuraxial block provide the safest option. Ilioinguinal and iliohypogastric nerve blocks with local infiltration by the surgeon allow inguinal hernia repair with minimal physiological disturbance. GA risks: difficult weaning from ventilation, post-operative respiratory failure requiring ICU. High spinal/epidural risks: intercostal paralysis, loss of accessory muscle function, cardiovascular instability. The patient can remain semi-recumbent, on their home oxygen, maintaining their own respiratory drive.

Reference: RCOA – 2023 – Respiratory disease and anaesthesia; NICE – 2018 – NG115 COPD